PSYCHOTIC DEPRESSION IN HEALTHCARE WORKERS DURING THE COVID-19 HEALTHCARE CRISIS: A CASE SERIES.

After the initial phases of the COVID-19 pandemic, new waves have occurred that have chronicled the epidemiological situation. This could especially affect the Mental Health of healthcare professionals with the appearance of serious conditions such as psychotic depression. The objective of this article is to describe a series of cases of psychotic depression in health professionals during the chronic phase of the sanitary crisis.

Shaped before birth: Obstetric complications identify a more severe clinical phenotype among patients presenting a first affective or non-affective episode of psychosis.

Obstetric complications (OCs) may contribute to the heterogeneity that characterizes psychiatric illness, particularly the phenotypic presentation of first episode psychoses (FEP). Our aim was to examine the relationship between OCs and socio-demographic, clinical, functioning and neuropsychological characteristics in affective and non-affective FEP. We performed a cross-sectional,study where we recruited participants with FEP between 2011 and 2021, and retrospectively assessed OCs using the Lewis-Murray scale. OCs were used as a dichotomous variable and further stratified into three subtypes: complications of pregnancy, abnormal fetal growth and development, and difficulties in delivery. We performed a logistic stepwise forward regression analysis to examine variables associated with the presence of OCs. Of the 104 participants (67 affective FEP and 37 non-affective FEP), 31.7% (n = 33) had experienced OCs. Subjects with OCs showed a more gradual emergence of prodromal symptoms as well as higher negative and total Positive and Negative Syndrome Scale (PANSS) scores. In the multivariate analysis, the presence of OCs was independently associated with a younger age at first episode of any type (OR = 0.904, p = 0.003) and slower emergence of prodromal symptoms (OR = 0.274, p = 0.011). When considering specific types of OCs, those related with fetal growth were associated with worse neuropsychological performance, while OCs at delivery were related to earlier onset of illness and more severe symptoms. In conclusion, OCs signaled a specific FEP phenotype characterized by earlier and more protracted onset of illness as well as more burdensome symptoms, independently of FEP type (i.e., affective vs non-affective). These results indicate a potential target of early intervention in FEP.

Cariprazine Use in Combination With a Mood Stabilizer in First Episode Mania.

Background: Cariprazine's efficacy and safety have been previously tested in adult patients with acute mania associated with bipolar I disorder, but there is no available data in FEM. The objective of this study is to assess the efficacy and safety of cariprazine in combination with a mood stabilizer in treating FEM as well as to evaluate patients' adherence to the treatment. Methods: FEM patients were recruited from the acute inpatient unit at Lleida University Hospital Santa Maria, between January and June 2021. Their symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Clinical Global Impressions-Severity (CGI-S) scale at admission and at discharge. Akathisia was assessed using the Barnes Akathisia Rating Scale. Patient adherence to medication treatment was assessed 30 days after discharge using the Morisky, Green and Levine Medication Adherence Scale. Socio-demographic and clinical information were further collected. Results: Eleven patients with FEM were involved, seven women and four men. Their mean age was 26.00+/-6.37 years. Mean hospitalization was 17.36+/-4.7 days. Cariprazine was combined with a mood stabilizer: lithium in seven patients and divalproex in four. Mean YMRS change from baseline was -24.55+/-7.5 and the mean CGI-S change from baseline was -2.55+/-0.82. Regarding adverse events, two (18.2%) patients presented with akathisia. At the 30-day treatment-adherence assessment, six (54.5%) patients were adherent and four (36.4%) had moderate adherence. Conclusion: In this sample, cariprazine in combination with mood stabilizers proved to be safe and effective in the treatment of FEM with more than half the patients being adherent to treatment. Therefore, cariprazine add-on is a good choice for promoting the long-term adherence of patients, thus minimizing the risk of relapse and improving prognosis.

Depresión psicótica en profesionalessanitarios durante la crisis sanitariapor COVID-19: una serie de casos / Psychotic depression in health professionals during the COVID-19 health crisis: a series of cases

Introducción. Tras las fases iniciales de la pandemia por COVID-19 se han sucedido nuevas oleadas que han cronificado la situación epidemiológica. Esto podría afectar de manera especial a la Salud Mental de los profesionales sanitarios con la aparición de cuadros graves como la depresión psicótica. El objetivo de este artículo es describir una serie de casos de depresión psicótica en profesionales sanitarios durante la fase crónica de la crisis sanitaria. Material y métodos. Reportamos una serie de casos que incluye tres pacientes profesionales sanitarios con depresión psicótica atendidos en el Hospital Universitario Santa María (Lérida, España) desde la finalización del primer estado de alarma (junio de 2020) hasta el final del segundo estado de alarma (mayo de 2021). Resultados. Los tres casos comparten la aparición de la sintomatología depresiva acompañada de síntomas psicóticos meses después de la fase aguda de la pandemia. Todos eran profesionales sanitarios y pertenecían a los grupos epidemiológicos de mayor riesgo. Ninguno de los pacientes presentó síntomas compatibles con la infección, aunque una paciente resultó COVID-19 positiva. Todos requirieron ingreso hospitalario y fueron tratados con la combinación de un antidepresivo y un antipsicótico con buena respuesta. Conclusiones. La fase crónica de la crisis sanitaria por COVID-19 tiene consecuencias importantes en la Salud Mental de los profesionales sanitarios por la aparición de cuadros graves como la depresión psicótica. Es necesario realizar un seguimiento específico a esta población de riesgo para prevenir la aparición de cuadros graves e iniciar el tratamiento en las fases iniciales.(AU)

Prodromal phase: Differences in prodromal symptoms, risk factors and markers of vulnerability in first episode mania versus first episode psychosis with onset in late adolescence or adulthood.

OBJECTIVE: This study was aimed at identifying differences in the prodromal symptoms and their duration, risk factors and markers of vulnerability in patients presenting a first episode mania (FEM) or psychosis (FEP) with onset in late adolescence or adulthood in order to guide tailored treatment strategies. METHODS: Patients with a FEM or FEP underwent a clinical assessment. Prodromes were evaluated with the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). Chi-squared tests were conducted to assess specific prodromal symptoms, risk factors or markers of vulnerability between groups. Significant prodromal symptoms were entered in a stepwise forward logistic regression model. The probabilities of a gradual versus rapid onset pattern of the prodromes were computed with logistic regression models. RESULTS: The total sample included 108 patients (FEM = 72, FEP = 36). Social isolation was associated with the prodromal stage of a FEP whilst Increased energy or goal-directed activity with the prodrome to a FEM. Physically slowed down presented the most gradual onset whilst Increased energy presented the most rapid. The presence of obstetric complications and difficulties in writing and reading during childhood were risk factors for FEP. As for markers of vulnerability, impairment in premorbid adjustment was characteristic of FEP patients. No specific risk factor or marker of vulnerability was identified for FEM. CONCLUSION: Early characteristics differentiating FEP from FEM were identified. These findings might help shape early identification and preventive intervention programmes.

Cariprazine-induced mania: A case series report.

Bipolar depression is the most prevalent phase of bipolar disorder (BD). There is a risk of inducing treatment-emergent affective switches (TEAS) with antidepressants (ADs). Hence, clinical guidelines do not recommend their use in monotherapy. Cariprazine is a dopamine-serotonin partial agonist, with a recent FDA approval as a monotherapy for BD type 1 (BD-I) depression. To our knowledge, there is no significant evidence of cariprazine-induced TEAS in bipolar depression. We describe three clinical cases of patients admitted to our acute psychiatric ward who developed manic episodes after the introduction of low doses of cariprazine. Two of the patients met the DSM-5 criteria for BD-I, and one for schizoaffective disorder, bipolar type. All patients were initially treated with low doses of cariprazine (1.5 mg) during a depressive phase. All three cases were simultaneously treated with mood stabilizers, regardless of which they switched to a manic episode when cariprazine was initiated. In our review of previous studies assessing the efficacy and side effects profile of cariprazine in BD-I, TEAS have not been found to be significant. However, according to our experience, cariprazine may induce affective switches in BD-I patients. Patients and psychiatrists should receive information regarding early warning symptoms and monitor possible cariprazine-induced mood switching.

High neutrophil-lymphocyte ratio upon admission is associated with better response in psychotic depression.

Recent evidence relates the inflammatory system to the aetiology and evolution of mood disorders. The Neutrophil-Lymphocyte Ratio (NLR) is an affordable and reproducible biomarker of inflammation. The aim of the study is to retrospectively evaluate the association between NLR and response to treatment in 50 patients aged over 50 with a diagnosis of Psychotic Depression (PD) who were admitted to an acute psychiatric unit between 2010 and 2018. They were stratified according to sex and treatment received: antidepressants, antipsychotics and electroconvulsive therapy (ECT). The NLR was collected on admission and the clinical response was quantified by the Global Assessment of Functioning (GAF) scale. In the simple linear regression, high NLR upon admission was associated with better clinical response during hospitalization as measured by GAF. When stratifying the patients, this association was maintained in women, in patients who received antidepressant treatment with tricyclics and SNRIs, antipsychotic treatment with olanzapine/quetiapine and those who did not receive ECT. NLR is an accessible biomarker in clinical practice, and in PD patients it could guide the therapeutic strategy and be a predictor of response.